2Centers of ExcellenceOntario Government is increasing treatment capacity by over 750%Guelph General Hospital is one of 5 Centers of Excellence for Bariatric Surgery (Gastric Bypass) in Ontario. (2 assessment centers)240 Bypass surgeries will be performed at Guelph General Hospital within a fiscal year. ( Dr. K Reed, Dr, Natasha Pereira Hong, Dr. Jules Foute Nelong)Support from Professional Staff for 5 years after surgery
3Selection of GGHGGH was selected in 2009 as a centre of excellence due to our expertise in Bariatric surgeryLead surgeon is Dr K Reed who has be providing this surgery in our community for over 10 years.Surgeons are required to perform a minimum of 50 Bariatric surgeries each, per year to be considered proficient in bariatric surgery
4Why? Obesity is a global epidemic Obesity is one of the leading causes of preventable deathExcess body fat impacts health which impacts health care costsIn Canada 47% of the population is either overweight or obese.The proportion of Canadian population which is obese has tripled in the last 15 yearsHealth problems include: CAD,cancer,hypertension,infertility,chronic muscular and joint problems and respiratory disease.
5Provincial Guidelines Age: Usually under age 60, not mandatoryBMI: 40 and over, 35 with some co morbidities such as diabetesGeographical Center of Excellence closest to youPsychologically and Medically fit for surgeryContraindications:Smoking - need to be smoke free for 6 monthsCurrent substance abuse (alcohol and drugs)Untreated significant psychiatric illness
6Who can refer a Patient Any family doctor Any Internist Windsor Bariatric Assessment Clinic referrals are direct to a bariatric surgeonAll referrals go to a central registry
7Orientation Classes Twice a month 20-25 patients plus significant others“Screens out” inappropriate patientsThey are then offered a date to start in clinicFirst appointment is 3 hours long to see all three professionals
8Before Surgery Attend several appointments at the Bariatric Clinic. Meet with the Social Worker, Dietitian and Nurse at least twice though often more timesMeet the Surgeon, Anesthetist and possibly an Internist
9Post op Routine Visit Schedule Up to 7 visits with various professional in first post op yearYearly to clinic after 1st year plus one surgeon visit at 18 months
10Nutrition Counselling Nutritional component includes a comprehensive pre op assessment to evaluate pre operative eating patterns/issuesManagement of post-operative nutrition begins with pre-operative nutrient statusFollow-up to reinforce important principles associated with long term weight loss and life style change
11Nutrition AssessmentMeet with a Registered Dietitian – details re: failed and recent weight loss attempts, lab values (Dyslipidemia) , snacking behaviour, cravings, disordered eating behaviours, food access, intolerancesA review of current eating habits – 24 hr. recallIdentification of potential beneficial changesCanada’s Food Guide – thorough review; activityFood JournalReassessment in 6- 8 weeksNeed to demonstrate ability to modify poor eating habits
13Psychosocial Assessment Why now? What is motivating you to have this surgery? What are your expectations? Are they realistic?Your understanding and ability to commit to the follow up provided by the clinic I.e. at least 3-4 appointments before surgery, at least 6 appointments in the first year following surgery and follow up for 5 years after surgery.
14Psychosocial Assessment continued…… The long term commitment to change – no smoking, no illicit drug use, limited alcohol, limited caffeine, no carbonated drinks.Long term commitment to dietary and lifestyle changesBudget restraints – cost of travel/parking, time off work for appointments, time off work for surgery, cost of vitamins, cost of Optifast
15Psychosocial Assessment Continued….. Anticipating major changes: ongoing medical follow-up, dietary, lifestyle, appearance and relationship changes.What supports do you have in place to help with this? Do you have individuals in your life who will sabotage you?Supports that are available i.e. bariatric clinic, support groups etc
16Psychosocial Assessment Continued Lifestyle changes – what will need to be changed, what has been challenging to change in the past, what will be different this time, do you know how to make changes, what can you start working on nowWhat coping strategies have you developed or need to develop to manage the ongoing lifestyle change required
17Psychosocial Assessment Continued….. Physical activity – why it is important i.e. to improve health before surgery and to achieve weight loss goal.How will you incorporate this into their life? Do you have goals? Can you start something now?
18Psychosocial Assessment Continued Do you have disordered eating? Any binge eating and/or emotional eating?What will be different following surgery?Have you ever received professional help for this? Do you need to or would you be willing to?
19Psychosocial Assessment We provide the you, the patient with an opportunity to do a Self Assessment I.e food/activity records, what your goals are, what are your triggers, what worked well, what was challengingWe focus on developing a new routine/plan, learning from past challenges, focusing on the present and recognize that nobody’s perfect.
20Psychosocial Assessment Continued…. Assessment of any history of mental health issue/diagnosis and whether this is stable etc. We will contact your mental health professional if appropriate.Assessment of any history of or current substance abuse challengesRecommend close follow up of medications that you are on d/t absorption changes etc.